By CBS News, from 60 Minutes website, February 19, 2012
Do antidepressants work? Since the introduction of Prozac in the 1980s, prescriptions for antidepressants have soared 400 percent, with 17 million Americans currently taking some form of the drug. But how much good is the medication itself doing? "The difference between the effect of a placebo and the effect of an antidepressant is minimal for most people," says Harvard scientist Irving Kirsch.
Kirsch's views are of vital interest to the 17 million Americans who take the drugs, including children as young as six and to the pharmaceutical industry that brings in $11.3 billion a year selling them.
Irving Kirsch is the associate director of the Placebo Studies Program at Harvard Medical School, and he says that his research challenges the very effectiveness of antidepressants.
Irving Kirsch: The difference between the effect of a placebo and the effect of an antidepressant is minimal for most people....
Kirsch: Well, it's not all in your head because the placebos can also affect your body. So if you take a placebo tranquilizer, you're likely to have a lowering of blood pressure and pulse rate. Placebos can decrease pain. And we know that's not all in the mind also because we can track that using neuro-imaging in the brain as well.
He says the doctors who prescribe the pills become part of the placebo effect.
Kirsch: A clinician who cares, who takes the time, who listens to you, who asks questions about your condition and pays attention to what you say, that's the kind of care that can help facilitate a placebo effect.
Dr. Walter Brown is a clinical professor of psychiatry at Brown University's Medical School. He has co-authored two studies that largely corroborate Kirsch's findings.
Brown: The number of antidepressant prescriptions over the last decade has increased and most troublesome, the biggest increase is in the mildly depressed, who are the ones who are least likely to benefit from them.
He says they're getting virtually no benefit from the chemical in the pill. Like most experts, he says these drugs do work for the severely depressed, but he questions the widely held theory that depression is caused by a deficiency in the brain chemical called serotonin, which most of these pills target.
Brown: The experts in the field now believe that that theory is a gross oversimplification and probably is not correct.
(Reporter Leslie) Stahl: And the whole idea of antidepressants is built around this theory?
Brown: Yes, it is.
To approve any drug, the Food and Drug Administration merely requires that companies show their pill is more effective than a placebo in two clinical trials - even if many other drug trials failed.
Brown: The FDA for antidepressants has a fairly low bar. A new drug can be no better than placebo in 10 trials, but if two trials show it to be better, it gets approved.
Stahl: Does that make sense to you?
Brown: That's not the way I would do it if I were the king. But I'm not.
Rest assured. Dr. Brown, many of us wish you were (king)!
When the pharmaceutical industry (against which this blog has railed for months) and the government's drug approval agency (Food and Drug Administration) are both dedicated to the American culture of profit above everything else, including exhaustive scientific trials demonstrating both the efficacy and the limited side effects of any drug, and the public is quite literally assaulted by a relentless campaign of advertising funded by the pharmaceutical industry, this is the kind of story that is, at least to this outside observer, inevitable.
Leslie Stahl told Kirsch in her piece on 60 Minutes, "This is a bomb!"
Dr. Kirsch agreed.
Dr. Brown, through his own independent studies, concurs.
The FDA spokesperson was less than unequivocal in his responses to Stahl's questions.
So just what is the size and scope of this hoax that has been perpetrated by those legitimate, law-abiding, tax-paying, upper echelon social elites who inhabit both the offices of the FDA and the Pharmaceutical company boardrooms, on an unsuspecting, naive, gullible and mildly depressed cadre of millions of Americans, not to mention a similar hoax in other countries, like Canada.
When the health care system is primarily dependent on a doctor's writing a prescription in order to get paid for an office visit, and when the patients come in with an already established list of requests for pills for whatever ailments (including depression, which is quite literally a catch-all for a multitude of discomforts) and the doctor knows that by writing the prescription, the insurance company will pay the bill, both for the drugs at the pharmacy and for his/her writing the prescription, then the inevitable occurs...he writes the prescription, often without even asking more than one or two questions about the nature, source and symptoms of the "ailment." S/He hasn't time to ask more penetrating questions.
Britain's clinical psychiatric spokesman, on 60 Minutes, concurred with the findings of Drs. Kirsch and Brown, and in Great Britain, there has been a significant curtailment of prescriptions for anti-depressants among mildly impacted patients. They have also begun to train a substantial cadre of "talking" therapists as replacements for the chemicals Brits have been pouring into and through their bodies, with little or no effect beyond what could be expected from a placebo.
Maybe the World Health Organization could consider establishing some minimal standards for the practice of medicine, in all countries, with a view to separating the pharmaceutical industry from the medical practitioners, demonstrating that they have established a firewall, and then monitoring the observance (or not) of that firewall in all developed countries, without fear of recrimination when they expose the relative compliance of the various countries.
The public deserves nothing less, and individual governments are unlikely to subscribe to a protocol that would wean the doctors off the teats of the industry, given the length and depth of the dependency.